II. Mechanism

  1. Sedative hypnotic
    1. Potentiates gamma-aminobutyric acid receptors
  2. No Analgesic effect
    1. Administer concurrent Analgesics
  3. Drug Abuse potential (especially among anesthesiologists, nurse anesthetists, emergency medicine staff, dentists)
    1. Increases Dopamine levels which may reinforce addiction
    2. Increases Serotonin levels which may be Hallucinogenic
    3. References
      1. Majoewsky (2012) EM:RAP 12(1): 3

III. Pharmacokinetics

  1. Rapid onset and short half-life
  2. Lipid-soluble and crosses blood-brain barrier
  3. Onset: 30-45 seconds
  4. Duration: 6 minutes (prolonged with repeated dosing)

IV. Dosing: Adults

  1. Deep Sedation (not FDA approved)
    1. Adult (preferred procedural sedative)
      1. Initial: 1 mg/kg IV over 20-30 seconds (typically given as smaller increments)
      2. Next: 0.5 mg/kg IV as needed every 3 minutes
      3. Decrease dose in older patients
    2. Child
      1. Initial: 1 mg/kg IV (up to 40 mg) over 20-30 seconds (typically given as smaller increments)
      2. Next: 0.5 mg/kg IV (up to 20 mg) as needed every 3 minutes
    3. Typically no respiratory depression at 1 mg/kg dose
      1. Amnesia occurs at this dose
    4. Perform painful procedures immediately following infusion
      1. Amnestic effect wears off prior to Sedation
  2. Intubation Sedation (not FDA approved)
    1. Dose 2 to 2.5 mg/kg IV over 20 to 30 seconds
  3. Ventilator Sedation in ICU
    1. Infusion: 5-50 mcg/kg/min
  4. Anesthesia
    1. Age under 55 years old
      1. Titration: 40 mg IV every 10 seconds until induction achieved
      2. Typical cummulative total dose: 2 to 2.5 mg/kg
      3. Maintenance infusion: 100-200 mcg/kg/min
    2. Age 55 years old or older
      1. Decrease dose from that list above for younger patients

V. Dosing: Children

  1. Deep Sedation (not FDA approved)
    1. Dose 1 mg/kg IV (up to 40 mg maximum) over 20 to 30 seconds
    2. May repeat 0.5 mg/kg IV (up to 20 mg maximum) as needed
    3. Avoid for prolonged ICU use
  2. Anesthesia (age 3 years and older)
    1. Typical cummulative total dose: 2.5 to 3.5 mg/kg over 20-30 seconds
    2. Maintenance infusion: 125-300 mcg/kg/min

VI. Indications

  1. Procedural Sedation and Analgesia (PSAA)
    1. Indicated for ASA Physical Status Score 2 (non-hypotensive, stable)
  2. Rapid Sequence Intubation

VII. Contraindications

  1. Soy allergy
  2. Egg allergy

VIII. Adverse Effects

  1. Propofol Infusion Syndrome
  2. Cardiopulmonary adverse effects (reduced by administering with lower dose and slower titration)
    1. Respiratory depression
    2. Hypotension and myocardial depression
      1. Consider Etomidate or Ketamine in hypotensive patients
      2. Phenylephrine may be used to counter the hypotensive effects of Propofol
  3. Overdose
    1. No antidote
    2. Manage with ABC Management and supportive care

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Ontology: Propofol (C0033487)

Definition (CHV) a kind of short-acting anesthetic
Definition (NCI) A hypnotic alkylphenol derivative. Formulated for intravenous induction of sedation and hypnosis during anesthesia, propofol facilitates inhibitory neurotransmission mediated by gamma-aminobutyric acid (GABA). This agent is associated with minimal respiratory depression and has a short half-life with a duration of action of 2 to 10 minutes.
Definition (PDQ) A hypnotic alkylphenol derivative. Formulated for intravenous induction of sedation and hypnosis during anesthesia, propofol facilitates inhibitory neurotransmission mediated by gamma-aminobutyric acid (GABA). This agent is associated with minimal respiratory depression and has a short half-life with a duration of action of 2 to 10 minutes. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=461189&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=461189&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C29384" NCI Thesaurus)
Definition (MSH) An intravenous anesthetic agent which has the advantage of a very rapid onset after infusion or bolus injection plus a very short recovery period of a couple of minutes. (From Smith and Reynard, Textbook of Pharmacology, 1992, 1st ed, p206). Propofol has been used as ANTICONVULSANTS and ANTIEMETICS.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D015742
SnomedCT 387423006, 74674007
LNC LP31828-4, MTHU015674
English Disoprofol, Propofol, 2,6 Diisopropylphenol, 2,6-Diisopropylphenol, Phenol, 2,6-bis(1-methylethyl)-, 2,6-Bis(1-methylethyl)phenol, propofol (medication), PROPOFOL, Propofol [Chemical/Ingredient], propofol, Propofol (product), Propofol (substance)
Swedish Propofol
Czech propofol
Finnish Propofoli
Russian DIZOPROFOL, PROPOFOL, ДИЗОПРОФОЛ, ПРОПОФОЛ
Japanese プロポホル, 2,6-ジイソプロピルフェノール, ジソプロホル, プロポフォール, ジソプロフォール
German BIS METHYLETHYL PHENOL 02 06 01, 2,6-Bis(1-Methylethyl)Phenol, Diisoprofol, Propofol
Polish Propofol
Spanish propofol (producto), propofol (sustancia), propofol, Disoprofol, Propofol
French Propofol
Italian Propofol
Portuguese Disoprofol, Propofol